JP2016515860A - System and method for determining sources of rotation associated with biological rhythm disorders - Google Patents

Abstract

Exemplary systems and methods for determining sources of rotation associated with heart rhythm disorders are disclosed. Multiple center positions of the wavefront are calculated at multiple time points related to the heart rhythm disorder. Next, a rotation path connecting the plurality of center positions is determined. The system and method can determine the dominant nuclei associated with the rotation path. A plurality of relative diffusion shapes associated with a plurality of center positions are calculated. A plurality of intersections of the minimum relative diffusion shape and other relative diffusion shapes are determined in the rotation path. The bounded polygon at the intersection is defined as the dominant nucleus. [Selection] Figure 1

Description

  This application relates generally to biological rhythm disorders. More specifically, the present application relates to a system and method for defining sources of rotation associated with biological rhythm disorders such as heart rhythm disorders.

  Heart rate (heart) rhythm disorders are common throughout the world and are representative of significant causes of illness and death. The malfunction of the electrical system in the heart is a representative example of a direct cause of heart rate rhythm disorders. Heart rhythm disorders exist in many forms, of which the most complex and difficult to treat are atrial fibrillation (AF), ventricular tachycardia (VT), and ventricular fibrillation (VF). Others including atrial tachycardia (AT), supraventricular tachycardia (SVT), atrial flutter (AFL), supraventricular ectopic contraction / beat (SVE), and ventricular extrasystole / beat (PVC) Rhythm disorders are easier to treat, but may also be clinically important.

  Until now, the treatment of heart rate rhythm disorders, particularly complex rhythm disorders such as AF, VF, and polymorphic VT, has been difficult due to the inability to identify the location within the heart that has the source of the heart rhythm disorder. . There have been various theories as to how complex rhythm disorders function, and clinical applications to treat these complex rhythm disorders. However, none of these applications have shown good results in the treatment of complex rhythm disorders.

  More recently, there has been a breakthrough in identifying for the first time the sources associated with complex heart rhythm disorders. This technological breakthrough is based on cardiac activation in signals obtained from catheter electrodes introduced into patients to identify rotational activation patterns (rotation sources) that are leading to a large proportion of heart rate rhythm disorders worldwide. The information (start time) was successfully reconstructed. Thus, the treatment of a heart rhythm disorder can target a source of rotation within the patient's heart to remove the heart rhythm disorder. Such treatment can be successfully accomplished, for example, by ablation.

  The source of rotation of a complex heart rhythm disorder can be identified as described above, but the range or width of rotation source propagation and its dominant center of rotation are not defined. In some cases, the source of rotation typically appears to rotate around an imaginary center of rotation, but one or more that tend to spread diffusively around a segment of the patient's heart May have many diffusion compartments (activated wavefronts). Diffusion activated wavefronts are associated with sources of complex rhythm disorders, but these wavefronts are more advanced than one or more other activation wavefronts of the rotation source with respect to progression of heart rate rhythm disorders. Is considered to contribute only mildly.

US Pat. No. 8,165,666

  There is no known system or method for defining a rotation source associated with a heart rate rhythm disorder that includes a rotation path associated with the rotation source and a dominant center of rotation.

  The present disclosure discloses a cardiac rhythm disorder in which biological activation information will be reconstructed to enable determination, diagnosis, and / or treatment of the source of rotation that causes the biological rhythm disorder, and Applicable to a variety of rhythm disorders including other biological rhythm disorders such as neurological seizures, esophageal cramps, unstable bladder, irritable bowel syndrome, and other biological disorders. However, it is particularly useful for the purpose of determining the nucleus of the rotation source of the disorder so that these disorders can be treated with high precision and convenience in complex rhythm disorders of the heart.

  Among the advantages of the present disclosure, reconstructed cardiac (or biological) activation information associated with a rhythm disorder rotation source is provided so that the nucleus of the rotation source can be determined and treated. There is a function to use.

  Another advantage is that the present invention can be implemented quickly while a sensing device such as a catheter with a sensor is used in or near a patient, further improving rhythm disturbances and in many cases It is a point to provide a system and a method capable of continuing the heart tissue treatment for curing. Therefore, calculating the nucleus of the source of rhythm disturbances gives the position in the patient of the nucleus to advance the rotation source so that treatment can be performed immediately after this calculation.

  Yet another advantage of the present disclosure is that accurate identification of the nuclei relative to the source of rotation can help remove heart rate rhythm disturbances while at the same time making a minor contribution to advancing the source of heart rate rhythm disorders. Other than that, which may not be, it is also useful in limiting or avoiding the destruction of healthy patient heart tissue.

  As used herein, the reconstructed activation information is signal data of a heartbeat signal or a biological signal, each of which is one or more of a biological rhythm disorder or a cardiac rhythm disorder. It has been processed to distinguish activation start times at distinct sensor positions from adjacent sensor or proximity sensor positions for many beats.

  As used herein, the activation onset time is the point at which activation begins in the patient's cells or tissues relative to other points in time of activation.

  As used herein, activation is the process by which a cell begins to move from an inactive (relaxed) state to an active (electrical) state.

  According to an embodiment or aspect, a method for determining a source of rotation associated with a cardiac rhythm disorder is disclosed. A plurality of center positions of the wavefront are calculated at a plurality of time points related to the heart rhythm disorder. The wavefront is related to the heartbeat signal. Next, a rotation path connecting the plurality of center positions is determined.

  The method can include determining a dominant nucleus associated with the rotation path. A plurality of relative diffusion shapes associated with a plurality of center positions are calculated. A plurality of intersections of the minimum relative diffusion shape and other relative diffusion shapes are determined in the rotation path. The bounded polygon at the intersection is defined as the dominant nucleus.

  According to an embodiment or aspect, a system for determining a source of rotation associated with a heart rhythm disorder is disclosed. The system includes a computing device and a machine-readable medium for storing instructions that cause the computing device to perform certain operations when executed by the computing device. Actuation includes calculating a plurality of center positions of the wavefront at a plurality of time points associated with the rotation source. The wavefront is related to the heartbeat signal. Actuation also includes determining a rotational path connecting a plurality of center positions.

  The computing device can perform operations to determine the dominant nuclei associated with the rotational path. These operations include calculating a plurality of relative diffusion shapes associated with a plurality of center locations. These operations also include determining a plurality of intersections of the minimum relative diffusion shape and other relative diffusion shapes in the rotational path. These operations further include defining the bounded polygon at the intersection as a dominant kernel.

  According to yet another embodiment or aspect, a tangible computer readable medium is stored that stores instructions that when executed by a processor cause the processor to perform an action to determine a rotation source associated with a heart rhythm disorder. Actuation includes calculating a plurality of center positions of the wavefront at a plurality of time points associated with the rotation source. The wavefront is related to the heartbeat signal. Actuation also includes determining a rotational path connecting a plurality of center positions.

  The tangible computer readable medium can store instructions that, when executed by the processor, cause the processor to perform operations to determine the dominant kernel associated with the rotational path. These operations include calculating a plurality of relative diffusion shapes associated with a plurality of center locations. These operations also include determining a plurality of intersections of the minimum relative diffusion shape and other relative diffusion shapes in the rotational path. These operations further include defining the bounded polygon at the intersection as a dominant kernel.

  The above-described embodiments or aspects may further access the reconstructed signal data of the heartbeat signal having an activation start time associated with the voltage at multiple time points. The signal data can be converted from the spline-sensor reference to a position having associated coordinates.

  The above-described embodiments or aspects may further determine the wavefront to include adjacent positions surrounded by positions having at least a threshold voltage level and lower than the threshold voltage level. The threshold voltage level can be a predetermined percentage of the highest voltage.

  The above-described embodiments or aspects can further determine a plurality of intersections of the minimum relative diffusion shape and other relative diffusion shapes that are inside the convex hull around the rotation path to define a dominant nucleus. This convex hull can be determined.

  The above-described embodiments or aspects can further include determining the center position of the wavefront. All the first coordinates of the position associated with the wavefront are averaged to generate a first average coordinate. All the second coordinates of the position associated with the wavefront are averaged to generate a second average coordinate. Thereafter, the center position of the wavefront is determined as a position identified by the first average coordinate and the second average coordinate.

  The above described embodiments or aspects can further calculate the relative diffusion shape of the wavefront. The calculation may include determining a distance from a position in the wavefront to the center position of the wavefront and calculating a circle having a radius equal to a predetermined multiplier multiplied by the standard deviation of the distance. it can. The predetermined multiplier may be equal to 2.

  The above and other objects, goals and advantages of the present application will become apparent upon reading the following detailed description in conjunction with the accompanying drawings.

  Some embodiments or aspects are shown by way of example and not limitation in the figures of the accompanying drawings.

FIG. 5 illustrates an example graphic mapping of an example source of rotation associated with a heart rhythm disorder in a patient. FIG. 2 illustrates an exemplary xy coordinate graphic mapping of the spline-sensor element of FIG. The first exemplary activation wavefront of the rotation source shown in FIG. 1 at a first exemplary time point when converted to a first wavefront (island) with a threshold applied to the associated voltage FIG. A second exemplary activation wavefront of the rotation source shown in FIG. 1 at a second exemplary time point when converted to a second wavefront (island) with a threshold applied to the associated voltage. FIG. FIG. 3 illustrates the averaging of xy coordinate positions contributing to the exemplary island represented by the xy coordinate graphic mapping of FIG. It is a figure which shows the average center position based on the calculation center position of the structure island of FIG. 3, FIG. 4 inside a vector path | route. FIG. 5 is a diagram illustrating relative spatial diffusion associated with a vector path of an island having a center position forming a vector path. FIG. 6 illustrates an exemplary method for calculating relative spatial spread of islands in relation to vector paths. FIG. 8 is a diagram showing the relative diffusion of the islands of FIG. 7 relative to their center position at each point in time relative to the vector path. FIG. 2 is a diagram illustrating an exemplary nucleus determination associated with the source of rotation of the heart rhythm disorder shown in FIG. 1. 2 is a flow diagram illustrating an exemplary method of determining a rotational path associated with a biological rhythm disorder rotation source such as the heart rhythm disorder rotation source shown in FIG. 1 is a block diagram of an exemplary embodiment of a general computer system.

  Disclosed herein are systems and methods for defining a rotational source of biological rhythm disorders such as heart rhythm disorders. In the following description, for the purposes of explanation, numerous specific details are set forth in order to provide a thorough understanding of the exemplary embodiments or aspects. However, it will be apparent to one skilled in the art that exemplary embodiments may be practiced without all of these specific details disclosed.

  FIG. 1 shows an exemplary graphic mapping 100 of an exemplary rotation source 106 associated with a heart rhythm disorder in a patient. For example, the rotation source 106 can be anywhere along the electrode reference 104 of a basket-type catheter (not shown) introduced into the patient's heart, between the vicinity of the electrodes 4-5-6 and the spline reference. Of an imaginary center of rotation 112 (one or more of the positions marked with a question mark) that may be determined by the physician to be anywhere along the spline B-C near 102 It is the source of heart rate rhythm disturbances in the right atrium of the patient's heart that are thought to progress in a counterclockwise rotational pattern. Note that different heart rate rhythm disturbance sources may be placed at different locations in different chambers of the heart and may rotate in different directions (eg, clockwise) around various centers of rotation. I want to be.

  The exemplary rotation source 106 can include a plurality of activation mappings 108, 110 that travel in a counterclockwise rotation pattern around a hypothetical rotation center 112, for example, over a cycle time of 100 ms to 300 ms. Each of the activation mappings 108, 110 can include an element 114 that represents the charge level (or voltage level) of the sensor at the spline reference 102 and sensor reference 104. Activation mapping 108, 110 provides reconstruction activation information (heartbeat signal reconstruction signal data) that identifies activation start times at multiple sensors for one or more beats of a cardiac rhythm disorder. Represents. For example, activation mapping 108, 110 is a system for reconstructing cardiac activation information that is patent-protected in US Pat. No. 8,165,666, which is incorporated herein by reference in its entirety. And by the method.

  For example, activation mapping 108, 110 (or activation wavefront) may be a monophasic action potential (MAP) voltage representation generated for a plurality of processed heartbeat signals shown in FIG. 11 of the '666 patent. it can. Specifically, a plurality of heartbeat signals are processed as described in the '666 patent, and a MAP representation is generated based on these processed signals. The electrical activity of all MAP representations can be mapped in a sequence showing exemplary activation mappings 108, 110 at different times, for example, the activation mapping 108 is earlier than the activation mapping 110. Although only two activation mappings 108, 110 (or activation wavefronts) are shown for clarity and brevity of the disclosure of the present invention, additional activation mappings are provided for rotation sources around the imaginary center of rotation 112. Note that it can be part of 106.

  Similarly, other systems and methods that can reconstruct cardiac activation information or biological activation information to generate rotation sources determine rotation paths and are associated with these rotation sources. It can be used as an input to the system and method of the present invention to identify potential rotating nuclei.

  In some cases, the rotation source 106 can have one or more diffusion sections, such as an activated wavefront 108. The activation wavefront 108 generally rotates around an imaginary center of rotation 112, spreads diffusively around a segment of the patient's heart, and is used to advance the heart rhythm disorder. It appears to contribute less lightly than one or more other activated wavefronts 110. Accordingly, FIGS. 2 to 11, which will be described in more detail below, determine the rotational path more accurately by calculation than the imaginary rotational center 112 described above with reference to FIG. It will explain whether to identify the nucleus.

  FIG. 2 shows an exemplary orthogonal (xy coordinate) graphic mapping 200. Orthogonal graphic mapping 200 includes one or more calculations and reconstructed signal data of heartbeat signals from spline / electrode references 102, 104 shown in graphic mapping 100 described with reference to FIGS. An exemplary method of converting to the xy coordinates shown in this orthogonal graphic mapping 200 used for determination is provided.

  For example, the orthogonal graphic mapping 200 extends from xy (0, 0) to xy (28, 28). The exemplary plurality of xy coordinate locations 202 may represent elements 114 of the activated wavefront 110 of FIG. From elements 114 of graphic mapping 100, coordinate positions 202 (including positions 204-212) and their associated charge (voltage) levels can be interpolated. Accordingly, other elements of the activated wavefronts 108, 110 of FIG. 1 can be converted to Cartesian coordinates as well.

The transformation Tx 214 can transform the xy coordinate position into a spline-electrode reference. For example, the xy coordinates (4, 8) can be converted to the following spline-electrode reference.
Spline = ((x + 1) / 4) + A = ((4 + 1) / 4) + A = 1.25 + A = B
Electrode = ((y + 1) / 4) +1 = ((8 + 1) / 4) + 1 = 2.25 + 1 = 3.25 = 3.

  In some embodiments, the spline-electrode reference value is rounded to the nearest spline integer value and electrode integer value. In various other embodiments, spline fractional values can be utilized in certain applications.

Transformation Rx216 is the inverse of transformation Tx214. The transformation Rx 216 can transform the above-described spline-electrode reference into an xy coordinate position. For example, the spline-electrode position B-3 can be converted into the following xy coordinate positions.
x = 4 (spline-A) = 4 (BA) = 4 (1) = 4,
y = 4 (electrode-l) = 4 (3-1) = 4 (2) = 8.

In the above example, the electrodes have the actual numeric benefits assigned to them. However, characters are assigned to splines. In order to perform the mathematical operations described above, the splines are A, B. . . H is 1,2. . . It is represented by a number such as 8. Therefore, the following spline calculation can be easily performed.
A−A = (l−1) = 0,
B−A = (2−l) = 1,
. . .
H-A = (8-1) = 7.

  A spline representation can be used to perform other spline calculations such as addition as well as other mathematical calculations.

FIG. 3 shows the sample activation wavefront 108 at the exemplary time T ₀ of the rotation source 106 shown in FIG. 1 converted to an orthogonal wavefront (island) 300 with a threshold applied to the associated charge (voltage). Show. Note that the island 300 looks similar to the activated wavefront 108 but represents only Cartesian coordinates located adjacent and greater than the charge (voltage) threshold, as described in more detail below. .

  More specifically, a threshold value of the upper 18% is applied to the charge (voltage) of the element in the activation wavefront 108. Thus, when the spline-electrode reference of the activated wavefront 108 is converted to the relevant location of the orthogonal wavefront (island) 300, it is identified for inclusion within the island 300 as described herein. The only positions that are marked and used for subsequent calculations are adjacent positions that are greater than the threshold charge (voltage). These positions are marked with threshold charge (voltage) levels. More specifically, an adjacent position larger than the threshold defines an island at a position larger than the threshold, and another position smaller than the threshold surrounds this island.

  Further, within the threshold, five charge (voltage) levels 324-332 (eg, the top 18% of charge relative to the island), each 3.6% of the threshold, can be defined. Specifically, the highest charge level 324 is defined as [0% to 3.6%] of the top 18% of the charge (voltage) in the activation wavefront 108. The charge levels 326, 328, 330, and 332 are respectively [3.6% to 7.2%], [7.2% to 10.8%], [10.8% to 14.4%], and [14.4% to 18.0%]. Although an 18% threshold is used, other thresholds can be defined.

As further shown in FIG. 3, eleven times T ₀ -T _N are associated with the rotation source 106 when the rotation source 106 completes the activation cycle. Each of the time points can be separated by about 10 ms to about 30 ms for a total time of about 100 ms to about 300 ms associated with a cycle of heart rhythm disorder as described herein. More time points associated with the heart rhythm disorder cycle can be used. For example, the time points can be separated by about 1 ms or separated by another longer period.

To calculate the center position 302 at the exemplary time T _0, the xy coordinate positions contributing to the island 300 are averaged. The calculation of the center position at a point in time is illustrated in more detail below with reference to FIG. Similarly, with respect to the island at time T ₁ through T _N, the center position 304. . . 322 is calculated.

Center positions 302, 304... In island 300 and others (all islands not shown) at times T _{0 to} T _N during the course of the complete cycle. . . 322 defines a vector path 301 associated with the dominant nucleus of the rotation source 106 shown in FIG. As shown in FIG. 3, the vector path 301 has center positions 302, 304. . . 322. Vectors 303, 305. . . 323.

FIG. 4 shows a sample activation wavefront 110 at the exemplary time T ₄ of the rotation source 106 shown in FIG. 1 converted to an orthogonal wavefront (island) 400 with a threshold applied to the associated charge (voltage). Is shown. To define island 400, calculations similar to those described above with reference to island 300 of FIG. 3 are performed.

Specifically, the xy coordinate positions contributing to the island 400 are averaged to calculate the center position 310 at the exemplary time point T ₄ . As described above, the center positions 302, 304... In the islands 300, 400 and others (all islands not shown) at times T _{0 to} T _N during the course of the complete cycle. . . 322 defines a vector path 301 associated with a dominant nucleus of the vector path 301, for example, a leading nucleus of the rotation source 106 shown in FIG.

  FIG. 5 illustrates the averaging of the xy coordinate positions contributing to the exemplary island represented by the graphic mapping 200 shown in FIG.

  As specifically shown in FIG. 5, the x-coordinates of positions 204-212 (shown in FIG. 2) within island 200 are averaged to determine an average x-coordinate of 5.2. Similarly, the y-coordinates of positions 204-212 (shown in FIG. 2) within the island 200 are averaged to determine an average y-coordinate of 8.6. Note that the xy coordinates of positions 204-212 represent the center of these positions.

  Accordingly, the calculated average of the x and y coordinates of the position within the island 200 defines the center position 502 for the island as the xy coordinate position (5.2, 8.6).

  6 shows the calculated center positions 302, 304... Of the constituent islands 300, 400 of FIG. 3, FIG. 4 and other islands (not shown) inside the vector path 301. . . An average center position 602 based on 322 is shown.

As shown in FIG. 6, the center position at the time T ₀ ~T _N 302,304. . . The average center position 602 based on 322 is converted to a spline-electrode reference (using FIG. 2) so that the xy coordinate position inside the vector path 301 is marked by the position shown in the triangle R _AVG . FIG. 6 shows that the electrode 5 is between the splines C-D.

Some diffusion islands, such as island 300 of FIG. 3, were expected to be between splines B-C (and electrodes 4-5-6) as described above with reference to FIG. It is clear that the calculated average of the center positions of all the islands tends to be biased toward the approximate center position (R _AVG ) of the vector path 301 rather than the position near the center of rotation 112. The following description using FIGS. 7-10 shows how to eliminate the bias caused by a diffusion island such as island 300. FIG.

  FIG. 7 illustrates the relative spatial diffusion 702, 704 of the islands 300, 400 in relation to the vector path 301 shown in FIGS. 3 and 4, as well as other islands (not shown) having a central position forming the vector path 301. Show.

  The source island (wavefront) of the rhythm disorder that is distributed (spread) over a relatively large portion of the heart (eg, the island 300) relative to the vector path 301 is the occurrence of the heart rhythm disorder. It may include locations that are affected not only by the source's leading nuclei, but also by other parts of the heart that are potentially unrelated to the electrical pathways associated with the leading rhythm disorder source It has been found.

  Furthermore, the location of the islands (wavefronts) concentrated within a relatively small spatial distribution (eg, island 400) relative to the vector path 301 is related to the electrical circuit driven by the dominant nucleus of the source of the heart rhythm disorder. Has been found to be related to the electrical pathways required to maintain a source of heart rhythm disturbances.

  An exemplary method for calculating the relative spatial diffusion associated with the vector path 301 is described below in connection with FIG. Other methods of determining relative diffusion can also be used.

  FIG. 8 shows an exemplary method 800 for calculating the relative spatial spread of islands relative to a vector path. In this example, the mapping 200 of FIG. 2 is considered to be an island (wavefront) where the coordinate position 502 at the coordinate position (5.2, 8.6) is located along the vector path.

  As shown in FIG. 5, the x-coordinates of positions 204 to 212 (shown in FIG. 2) within the island 200 are averaged to determine an average x-coordinate of 5.2. Similarly, the y-coordinates at positions 204-212 (shown in FIG. 2) within the island 200 are also averaged to determine an average y-coordinate of 8.6. Accordingly, the calculated center position 502 for the island 200 is an xy coordinate pair (5.2, 8.6).

  A distance d802 is determined for each of the positions 204-212. The distance d802 represents the distance from the xy coordinate of each position to the calculation center position 502 of the island 200. For example, the expression 808 indicates that the distance calculation 804 for calculating the distance d802 from the position 208 (4, 9) to the center position 502 (5.2, 8.6) is d = 1.265. . Similarly, the distance d is calculated for all other constituent positions of the island 200. The distance d associated with all locations 204-212 on island 200 is provided in table 803.

  The relative diffusion of the island 200 is represented by a circle 804 having a radius 806 from the central location 502 equal to the secondary standard deviation of the distance from all locations 208-212 to the central location 502 of the island 200. For example, radius 806 is given by equation 810 where the standard deviation of all distances is s = 0.894 and the secondary standard deviation is 2s = 1.788. Accordingly, the relative diffusion of the island 200 is represented by a circle having a radius of 1.788 from the center position 502 (5.2, 8.6).

  The relative diffusions 702, 704 of the islands 300, 400 associated with the vector path 301 shown in FIG. 7 as well as other islands (not shown) having a central location that forms or lies along the vector path 301 are described above. The exemplary method 800 can be calculated.

FIG. 9 shows the relative diffusion of these islands relative to the center positions 302, 310 of the islands 300, 400 of FIG. 7 at the respective time points t ₀ , t ₄ , and the respective time points t ₁ -t ₃ , t ₅ -t _N. The relative diffusions 902-922, which are the relative diffusion of these islands relative to the center positions 304-308, 312-322 of other islands (not shown), are shown in the vector path 301. It is related.

As shown, the spatial distribution 902-922 represents the calculated circles 902-922 representing the island relative distribution or relative diffusive radius is associated with a vector path 301 at time t ₀ ~t _N. Leading nucleus of rotating source (e.g., an imaginary rotation center 112 shown in FIG. 1) each of the relevance of the circle 902 to 922 with respect to the size of each circle 902 to 922 at each time point t ₀ ~t _N Inversely proportional to However, the average position R _AVG 602 tilts towards a larger circle (having a larger radius). Therefore, it is expected that the leading nucleus of the rotation source will be placed at a position toward the smaller circles 910-916.

  FIG. 10 illustrates an exemplary dominant nucleus 1018 determination associated with the heartbeat rhythm disorder rotation source 106 shown in FIG.

As specifically shown in FIG. 10, the vector path 301 connects the center positions 302 to 322 (shown in FIG. 3) at all points related to the vector path 301. A convex skin 1002 is determined for the vector path 301. The convex skin 1002 represents a convex shape around the vector path 301 composed of the center positions 302 to 322 at the time points t _{0 to} t _N.

  More specifically, the convex hull is the smallest convex polygon surrounding a set of (x, y) coordinate positions. A convex skin can be thought of as a shape formed by stretching a rubber band around a set of coordinate positions to define a set of outer perimeters. Therefore, the coordinate positions not located on the outer periphery are internal and do not contribute to shape expansion.

  Computational geometry includes several established algorithms for constructing a convex hull. An example of such an algorithm includes a so-called gift wrapping algorithm that finds a convex shortest flat side surrounding a set of points. The gift wrapper algorithm completes the round around the point set (for example, the last side touches the first side), resulting in a convex polygon (convex hull) resulting in the outer edge of the point set It operates by folding a virtual wrapping paper sheet around the counterclockwise.

  Thus, the convex skin 1002 has an outer periphery, eg, vectors 303, 305. . . By ignoring the internal protrusion of the vector path 301 extending in a zigzag manner in H.323, the entire circumference of the vector path 301 is determined to be smooth. The degree of difference between the shape of the vector path 301 and the shape of the convex hull 1002 around the vector path 301 can indicate a measure of eccentricity associated with the vector path 301 (eg, many internal protrusions are more Will show an irregular vector path 301).

  A circle having a minimum radius (eg, the minimum circle 912) has its center position 310 (shown in FIG. 3) selected as an anchor. Inside the convex skin 1002, starting from the smallest circle 912, adjacent circles 910, 914, 916, 918 and 920 determine intersection sets 1004-1014 that define the inscribed polygon 1016 inside the convex skin 1002.

Thereafter, the promising nucleus R _core 1018 of the rotation source 106 related to the heartbeat rhythm disorder shown in FIG. 1 intersects 1004 to 1014 representing a bounded convex polygon inside the intersection set 1004 to 1014 in the convex skin 1002. As a subset (for example, an inscribed polygon 1016).

  FIG. 11 determines a rotation path associated with a rotation source of a biological rhythm disorder, such as the heartbeat rhythm disorder rotation source 106 shown in FIG. 1, and identifies the dominant nuclei associated with this rotation source. 5 is a flow diagram illustrating an exemplary method 1100. The exemplary method 1100 may be implemented by a computer system 1200 described in more detail below with reference to FIG.

More specifically, exemplary method 1100 begins at operation 1102 and provides reconstructed signal data (eg, having an assigned activation start time) associated with heartbeat rhythm disorder rotation source 106 of FIG. Or the method 1100 can access these data. In act 1104, a time point, such as time point T ₀ , is selected from time points T _{0 to} T _N as shown in FIG.

  In act 1106, reconfiguration signal data associated with the selected time point is accessed. In act 1108, the signal data is converted from the spline-electrode reference to a Cartesian coordinate position related to the voltage level at the activation start time. An exemplary transformation has been described with reference to FIG.

In act 1110, a threshold level is applied to the coordinate position and the coordinate position is marked based on the selected time, eg, the higher charge (voltage) level in the signal data at T ₀ . As described herein above with reference to FIG. 3, a threshold level representing the top 18% charge or another threshold level may be applied to the coordinate location.

  In act 1112, an island (wavefront) is determined that includes adjacent coordinate positions that are at or above a threshold level surrounded by coordinate positions below the threshold level. An exemplary island determination has been described with reference to FIGS. In act 1114, the center position relative to the coordinate position within the island is calculated. An exemplary calculation of the central location within the island has been described with reference to FIG.

  In act 1116, the relative diffusion of the islands is determined. The relative diffusion can be a circle having a radius that represents the diffusion of the location within the island. An exemplary calculation of relative diffusion has been described with reference to FIG.

  Note that the above-described data that is accessed, transformed, determined, and calculated can be stored for subsequent use in accordance with the exemplary method 1100 (such as in a computer memory or storage device). ).

In act 1118, a determination is made as to whether there are more time points to process, eg, time points T ₁ -T _N. If it is determined at operation 1118 that there are more time points to process, operation 1104 for the next time point (eg, time point T ₁ ) until all time points (T ₀ -T _N ) have been processed. ˜1116 is repeated, and so on. If a determination is made at act 1118 that there are no more time points to process, method 1100 continues to act 1120.

Thereafter, in act 1120, vector paths connecting the center positions at all of the time points (T ₀ -T _N ) are determined. An exemplary determination of the vector path has been described with reference to FIG. In act 1122, a convex hull is determined from the vector path. An exemplary determination of the convex hull has been described with reference to FIG.

  In act 1124, the circle with the smallest radius (the smallest circle) is selected. Then, in act 1126, a set of intersection points (eg, inscribed polygons) associated with the smallest circle and other circles anchored to their center position inside the convex hull is determined. In act 1128, a determination is made as to whether a bounded convex polygon can be formed inside the set of intersection points within the convex skin. If it is determined that a bounded convex polygon can be formed, the method 1100 continues to operation 1130. Alternatively, the method continues to operation 1132.

  In act 1130, the dominant nucleus of the heartbeat rhythm disturbance source 106 of FIG. 1 is defined as the intersection subset forming a bounded convex polygon inside the convex skin. Examples of operations 1124-1130 have also been described with reference to FIG. In operation 1132, method 1100 ends.

  In operation, the cardiac rhythm disorder rotation source 106 shown in FIG. 1 defined in accordance with the above disclosure can be treated in the patient's heart to remove the cardiac rhythm disorder. For example, in this case, the patient's heart tissue on or in the defined rotational path 301 can be targeted for treatment. If a dominant nucleus 1018 is identified, the heart tissue on or in the dominant nucleus 1018 can be targeted for treatment, except for the heart tissue outside the dominant nucleus 1018. In various cases, a margin greater than the rotational path 301 or the dominant nucleus 1018 can be established for therapeutic purposes. For example, a heart tissue region that is slightly larger (eg, one millimeter or several millimeters) than the rotational path 301 or the dominant nucleus 1018 can be targeted for treatment.

  The treatment can be successfully performed on the target heart tissue (rotational path 301 with or without margin or powerful nucleus 1018) by ablation, for example. Of course, other treatments of the target heart tissue, such as various energy sources (including but not limited to radio frequency, cryogenic energy, microwave, and ultrasound), gene therapy, stem cell therapy, pacing stimuli, drugs, Or other therapies are possible.

  FIG. 12 is a block diagram of an exemplary embodiment of a general computer system 1200. Computer system 1200 includes a set of instructions that can be executed to cause computer system 1200 to perform any one or more of the methods or computer-based functions disclosed herein. Can do. Computer system 1200, or any portion thereof, can operate as a stand-alone device or can be connected to other computer systems or peripheral devices using, for example, network 1224 or other connections.

  Computer system 1200 specifies a personal computer (PC), tablet PC, personal digital assistant (PDA), mobile device, palmtop computer, laptop computer, desktop computer, communication device, control system, web equipment, or action to be taken A set of instructions can be executed (sequentially or otherwise), implemented as various devices, such as any other machine, or incorporated into these devices. Further, although a single computer system 1200 is shown, the phrase “system” is intended to execute one or more sets of instructions individually or jointly to perform one or more computer functions. It should also be taken to include any set of systems or subsystems.

  As shown in FIG. 12, the computer system 1200 may include a processor 1202, for example, a central processing unit (CPU), a graphics processing unit (GPU), or both. Further, the computer system 1200 can include a main memory 1204 and a static memory 1206 that can communicate with each other through a bus 1226. As shown, the computer system 1200 may further include a video display unit 1210 such as a liquid crystal display (LCD), an organic light emitting diode (OLED), a flat panel display, a solid state display, or a cathode ray tube (CRT). Further, the computer system 1200 can include an input device 1212 such as a keyboard and a cursor control device 1214 such as a mouse. The computer system 1200 can include a disk drive unit 1216, a signal generation device 1222 such as a speaker or remote control, and a network interface device 1208.

  In the particular embodiment or aspect depicted in FIG. 12, the disk drive unit 1216 may be encoded or stored with one or more sets of instructions 1220, eg, software embedded therein. Media or computer readable media 1218 may be included. Further, the instructions 1220 may implement one or more of the methods or logic described herein. In certain embodiments or aspects, instructions 1220 may be wholly or at least partially in main memory 1204, static memory 1206, and / or in processor 1202 during execution by computer system 1200. it can. Main memory 1204 and processor 1202 may include computer readable media.

  In alternative embodiments or aspects, such as application specific integrated circuits, programmable logic arrays, and other hardware devices to perform one or more of the methods described herein. A dedicated hardware implementation can be configured. Applications that can include the devices and systems of the various embodiments or aspects can broadly include a variety of electronic computer systems. One or more embodiments or aspects described herein may include two or more specific hardware modules or devices interconnected between and by these modules. The functions can be implemented with associated control and data signals that can be communicated or as part of an application specific integrated circuit. Accordingly, the system of the present invention encompasses software implementation, firmware implementation, and hardware implementation.

  In accordance with various embodiments or aspects, the methods described herein can be implemented by a software program tangibly embodied in a processor-readable medium and executed by a processor. Further, in an exemplary, non-limiting embodiment or aspect, implementation can include distributed processing, component / object distributed processing, and parallel processing. Alternatively, a virtual computer system process can be configured to perform one or more of the methods or functions described herein.

  Accepting and executing instructions 1220 in response to a propagated signal such that a computer readable medium includes instructions 1220 or a device connected to network 1224 can communicate voice, video, or data over network 1224; I also think. Further, instructions 1220 can be transmitted or received over a network through network interface device 1208.

  Although a computer-readable medium is shown as being a single medium, the phrase “computer-readable medium” refers to a centralized or distributed database and / or their associated set of instructions that store one or more sets of instructions. Includes one or more media such as caches and servers. The phrase “computer-readable medium” can store or encode a set of instructions for execution by a processor, or any one or more of the methods or operations disclosed herein. Any tangible medium that causes a computer system to implement many should also be included.

  In certain non-limiting exemplary embodiments or aspects, the computer-readable medium includes a semiconductor memory such as a memory card or other package that includes one or more non-volatile read-only memories. Can do. Further, the computer readable medium can be a random access memory or other volatile rewritable memory. In addition, computer readable media can include magneto-optical or optical media such as a disk, tape, or other storage device for capturing and storing carrier signals such as signals communicated through a transmission medium. . As a distributed medium that is equivalent to a tangible storage medium, a digital file attachment to an email or other self-contained information archive or set of archives can be considered. Accordingly, this specification includes any one or more of computer-readable or distributed media, other equivalents, and successor media that can store data or instructions.

  In accordance with various embodiments or aspects, the methods described herein can be implemented as one or more software programs running on a computer processor. Specialized hardware implementations, including but not limited to application specific integrated circuits, programmable logic arrays, and other hardware devices can also be configured to implement the methods described herein. Further, other software implementations can be configured to implement the methods described herein, including but not limited to distributed processing or component / object distributed processing, parallel processing, or virtual machine processing.

  Software that implements the disclosed methods may be a magnetic medium such as a disk or tape, a magneto-optical or optical medium such as a disk, a solid medium such as a memory card, or one or more read-only (non-volatile) It should also be noted that it can optionally be stored on a tangible storage medium, such as other packages including memory), random access memory, or other rewritable (volatile) memory. Software can make use of signals including computer instructions. As a distributed medium that is equivalent to a tangible storage medium, a digital file attachment to an email or other self-contained information archive or set of archives can be considered. Accordingly, this specification includes the tangible storage or distribution media listed herein as well as other equivalent and successor media capable of storing the software implementations herein.

  Thus, a system and method for defining a source of rotation associated with a biological rhythm disorder such as a heart rhythm disorder has been described herein. Although particular exemplary embodiments or exemplary aspects have been described, it will be apparent that various modifications and variations can be made to these embodiments or aspects without departing from the broad scope of the invention. Accordingly, the specification and drawings are to be regarded in an illustrative sense rather than a restrictive sense. The accompanying drawings, which form a part of this specification, illustrate by way of example and not limitation, specific embodiments or aspects in which the subject matter may be practiced. Illustrative embodiments or aspects have been described in sufficient detail to enable those skilled in the art to practice the teachings disclosed herein. Other embodiments or aspects may be utilized and derived from these embodiments or aspects so that structural and logical substitutions and changes can be made without departing from the scope of the present disclosure. Accordingly, this description is not to be taken in a limiting sense, and the scope of the various embodiments or aspects is intended to cover the scope of the claims and all equivalents to which such claims are entitled. Determined only by.

  Such embodiments or aspects of the inventive subject matter are merely for convenience and scope of the application to any single invention or indeed to the inventive concept if more than one is disclosed. Without being considered as limiting in any way, the phrase “invention” may be referred to herein individually and / or collectively. Thus, although specific embodiments or aspects have been illustrated and described herein, it is understood that any configuration calculated to provide the same purpose can be substituted for the specific embodiments or aspects illustrated. Must. This disclosure is intended to cover any and all modifications or variations of various embodiments or aspects. Upon review of the above description, combinations of the above-described embodiments or aspects and other embodiments or aspects not specifically described herein will be apparent to those skilled in the art.

  Provides a summary in accordance with “37CFR §1.72 (b)”, which enables readers to quickly ascertain the nature and gist of the technical disclosure. Will. This Abstract is submitted with the understanding that it will not be used to interpret or limit the scope or meaning of the claims.

  In the foregoing description of embodiments or aspects, various features are grouped together in a single embodiment to facilitate the disclosure of the present invention. This method of disclosure is not to be interpreted as reflecting that the claimed embodiments or aspects have more features than are expressly recited in each claim. Contrary to the foregoing, the subject matter of the invention resides in less than all features of a single embodiment or aspect disclosed, as reflected in the claims that follow. Thus, the following claims are hereby incorporated into the Detailed Description, with each claim standing on its own as a separate exemplary embodiment or example. It is contemplated that the various embodiments or aspects described herein can be combined or combined into different combinations not explicitly mentioned herein. Further, the claims including such different combinations can also be independently established as separate exemplary embodiments or exemplary aspects that can be incorporated into the “DETAILED DESCRIPTION”. thinking.

100 Graphic mapping 102 Spline reference 104 Electrode reference 106 Rotation source 112 Imaginary rotation center

Claims (30)

A method for determining a source of rotation associated with a heart rhythm disorder,
Calculating, by a computing device, a plurality of center positions of a wavefront associated with a heartbeat signal at a plurality of times associated with the rotation source;
Determining a rotation path connecting the plurality of central positions by the computing device;
A method comprising the steps of: Further comprising accessing the reconstructed signal data of the heartbeat signal;
The reconstructed signal data has activation start times associated with voltages at the plurality of time points;
The method according to claim 1.   The method of claim 2, further comprising converting the reconstructed signal data from spline-sensor reference to xy coordinate positions.   The method of claim 1, further comprising determining each of the wavefronts to include at least a threshold voltage level and adjacent positions surrounded by a position below the threshold voltage level.   The method of claim 4, wherein the threshold voltage level is a predetermined percentage of a maximum voltage.   The method of claim 1, further comprising determining a dominant nucleus associated with the rotation path. The determination of the dominant nucleus associated with the rotation path is
Calculating a plurality of relative diffusion shapes associated with the plurality of center positions;
Determining a plurality of intersections of a minimum relative diffusion shape and other relative diffusion shapes in the rotational path;
Defining the bounded polygon of the intersection as the dominant core;
including,
The method according to claim 6. The calculation of the relative diffusion shape is
Determining a distance from a position in the wavefront to a center position of the wavefront;
Calculating a circle having a radius equal to a predetermined multiplier multiplied by the standard deviation of the distance;
including,
The method according to claim 7. The determination of the dominant nucleus associated with the rotation path is
Determining a convex hull around the rotation path;
Calculating a plurality of relative diffusion shapes associated with the plurality of center positions;
Determining a plurality of intersections of a minimum relative diffusion shape and other relative diffusion shapes inside the convex skin;
Defining the bounded polygon of the intersection as the dominant core;
including,
The method according to claim 6. The calculation of the center position of the wavefront is
Averaging all first coordinates of positions associated with the wavefront to generate first average coordinates;
Averaging all second coordinates of the position associated with the wavefront to generate a second average coordinate;
Defining the center position of the wavefront as a position identified by the first average coordinate and the second average coordinate;
including,
The method according to claim 1. A system for determining a source of rotation associated with a heart rhythm disorder,
A computer device;
Calculating a plurality of center positions of a wavefront associated with a heartbeat signal at a plurality of time points associated with the source of rotation, when executed by the computing device, and connecting the plurality of center positions Determining the rotation path;
A machine-readable medium storing instructions for performing operations including:
A system characterized by including.   The system of claim 11, wherein the actuating further comprises accessing reconstructed signal data of the heartbeat signal having an activation start time associated with voltages at the plurality of times.   The system of claim 12, wherein the actuating further comprises converting the reconstructed signal data from a spline-sensor reference to an xy coordinate position.   12. The act of claim 11, further comprising determining each of the wavefronts to include an adjacent position surrounded by a position having at least a threshold voltage level and lower than the threshold voltage level. The system described.   The system of claim 14, wherein the threshold voltage level is a predetermined percentage of a maximum voltage.   The system of claim 11, wherein the actuating further comprises determining a dominant nucleus associated with the rotational path. The operation for determining the dominant nucleus associated with the rotational path is:
Calculating a plurality of relative diffusion shapes associated with the plurality of center positions;
Determining a plurality of intersections of a minimum relative diffusion shape and other relative diffusion shapes in the rotational path;
Defining the bounded polygon of the intersection as the dominant core;
Further including
The system of claim 16. The operation for the calculation of the relative diffusion shape is
Determining a distance from a position in the wavefront to a center position of the wavefront;
Calculating a circle having a radius equal to a predetermined multiplier multiplied by the standard deviation of the distance;
Further including
The system according to claim 17. The operation for determining the dominant nucleus associated with the rotational path is:
Determining a convex hull around the rotation path;
Calculating a plurality of relative diffusion shapes associated with the plurality of center positions;
Determining a plurality of intersections of a minimum relative diffusion shape and other relative diffusion shapes inside the convex skin;
Defining the bounded polygon of the intersection as the dominant core;
Further including
The system of claim 16. The operation for calculating the center position of the wavefront is
Averaging all first coordinates of positions associated with the wavefront to generate first average coordinates;
Averaging all second coordinates of the position associated with the wavefront to generate a second average coordinate;
Defining the center position of the wavefront as a position identified by the first average coordinate and the second average coordinate;
Further including
The system according to claim 11. A tangible computer readable medium storing instructions that, when executed by a processor, cause the processor to perform operations to determine a rotation source associated with a heart rhythm disorder,
The operation is
Calculating a plurality of center positions of a wavefront associated with a heartbeat signal at a plurality of time points associated with the rotation source;
Determining a rotation path connecting the plurality of center positions;
including,
A tangible computer readable medium characterized by the above.   The tangible computer of claim 21, wherein the actuating further comprises accessing reconstructed signal data of the heartbeat signal having an activation start time associated with voltages at the plurality of times. A readable medium.   The tangible computer readable medium of claim 22, wherein the actuating further comprises converting the reconstructed signal data from a spline-sensor reference to an xy coordinate position.   The act of further comprising: determining each of the wavefronts to include an adjacent position surrounded by a position having at least a threshold voltage level and lower than the threshold voltage level. The tangible computer readable medium described.   The tangible computer readable medium of claim 24, wherein the threshold voltage level is a predetermined percentage of a maximum voltage.   The tangible computer readable medium of claim 21, wherein the actuating further comprises determining a dominant nucleus associated with the rotational path. The operation for determining the dominant nucleus associated with the rotational path is:
Calculating a plurality of relative diffusion shapes associated with the plurality of center positions;
Determining a plurality of intersections of a minimum relative diffusion shape and other relative diffusion shapes in the rotational path;
Defining the bounded polygon of the intersection as the dominant core;
Further including
27. A tangible computer readable medium according to claim 26. The operation for the calculation of the relative diffusion shape is
Determining a distance from a position in the wavefront to a center position of the wavefront;
Calculating a circle having a radius equal to a predetermined multiplier multiplied by the standard deviation of the distance;
Further including
28. A tangible computer readable medium according to claim 27. The operation for determining the dominant nucleus associated with the rotational path is:
Determining a convex hull around the rotation path;
Calculating a plurality of relative diffusion shapes associated with the plurality of center positions;
Determining a plurality of intersections of a minimum relative diffusion shape and other relative diffusion shapes inside the convex skin;
Defining the bounded polygon of the intersection as the dominant core;
Further including
27. A tangible computer readable medium according to claim 26. The operation for calculating the center position of the wavefront is
Averaging all first coordinates of positions associated with the wavefront to generate first average coordinates;
Averaging all second coordinates of the position associated with the wavefront to generate a second average coordinate;
Defining the center position of the wavefront as a position identified by the first average coordinate and the second average coordinate;
Further including
22. A tangible computer readable medium according to claim 21.

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